Socio-Demographic characteristics
Out of 420 study participants, 407 have participated in the study making a response rate of 96.9%. More than three-fourth, 61.9% of the study participants were females and the mean (± SD) age of the participants was 35.21 (± 8.78). More than two-thirds 70% of the participants were married and 63.9% were rural residents. Around 92.6% of respondents' families had less than five family sizes with a mean (±SD) family size were 3.6 (±1.3). The majority, 75.9% of the participants was Muslim by religion and 98.3% were Amhara ethnic group. Around two-fifth, 42% of the participants were farmers and 40.8% were illiterate (unable to write and read). The mean (±SD) income of the study participants was 1385(±1177) ETB (55.4 ±47.08 USD). (Table 1)
Table 1
Socio-demographic characteristics of adult people living with HIV on ART in Dessie referral hospital of south Wollo Zone, north-central Ethiopia 2021.
Variables
|
|
Frequency
|
Percent
|
Sex
|
Male
Female
|
155
252
|
38.1
61.9
|
Age in years
|
18-25
26-35
36-44
≥45
|
59
163
111
74
|
14.5
40
27.3
18.2
|
Residence
|
Urban
Rural
|
147
260
|
36.1
63.9
|
Marital status
|
Single
Married
Divorced
Widowed
|
58
285
32
32
|
14.3
70
7.9
7.9
|
Number of family members
|
≤ 5
> 5
|
377
30
|
92.6
7.4
|
Educational status
|
Illiterate, unable to read and write
Illiterate, able to read and write
Primary (1-8)
High school (9-12)
Collage and above
|
166
68
80
63
29
|
40.8
16.7
19.7
15.5
7.1
|
Ethnicity
|
Amhara
Tigrai
|
400
7
|
98.3
1.7
|
Religion
|
Protestant
Orthodox
Muslim
|
17
81
309
|
4.2
19.9
75.9
|
Occupational status
|
Farmer
Merchant
Government employer
House wife
Daily labor
Student
|
171
31
25
66
98
16
|
42.0
7.6
6.1
16.2
24.1
3.9
|
Head of household
|
Male
Female
|
228
179
|
56
44
|
Living condition
|
Alone
With parents
With relatives
With spouse
|
60
182
22
143
|
14.7
44.7
5.4
35.1
|
Average monthly income
|
≤ 40 USD
>40 USD
|
238
169
|
58.5
41.5
|
Nutritional characteristics
Among the total study participants, 19.66% had a BMI of < 18.5 kg/m2 (underweight), 71.99% were in the normal range, and 8.35% have BMI ≥25 kg/m2 (Overweight). One-third, 33.2% of the participants had actual daily meal patterns less than 3 times per day which is below the daily recommended meal frequency for PLHIV on ART. Dietary diversity score was assessed using 9 food items dietary diversity scale in the study group. Accordingly, 51.6% of the study participants have inadequate dietary diversity scores (Table2)
Table 2
Health-related and immunological profiles of ART patients in Dessie referral Hospital of South Wollo Zone, North-central Ethiopia, June25-July25, 2021.
Variables
|
Category
|
Frequency
|
Percentage
|
CD4+ T cell count
|
<350
350-500
>500
|
251
68
88
|
61.7
16.7
21.6
|
WHO clinical stage
|
Stage I& II
Stage III&IV
|
315
92
|
77.2
22.5
|
Duration on ART
|
<12 months
≥12 months
|
39
368
|
9.6
90.4
|
ART regimens
|
1J(TDF+3TC+DTG)
1E(TDF+3TC+EFV)
2H(TDF+3TC+ATV/r)
|
311
81
15
|
76.4
19.9
3.7
|
Developing OIs in the past six months
|
No
|
249
|
61.2
|
Yes
|
Disease
|
158
|
38.8
|
|
TB
|
17
|
17.9
|
Pneumonia
|
110
|
69.6
|
Oral thrush
|
10
|
10.5
|
Zoster
|
3
|
3.2
|
Diarrhea
|
36
|
37.9
|
Any support from governmental or non-governmental organization
|
No
|
352
|
86.5
|
Yes Support
|
55
|
13.5
|
|
Money
|
28
|
60
|
Food
|
16
|
29
|
Loan
|
36
|
65
|
Equipment
|
4
|
7
|
Other person living with HIV on ART in the family
|
No
|
178
|
43.7
|
Yes
|
Persons
|
229
|
56.3
|
Spouse
|
191
|
83.4
|
Child
|
36
|
15.7
|
Parents
|
26
|
11.4
|
Other relatives
|
3
|
1.3
|
Functional status
|
Working
Ambulatory
|
377
30
|
92.6
7.4
|
Clinical characteristics
The mean (± SD) CD4 T-Lymphocyte cell count of the study participants was 476.50 (±235.33). More than one-fifth, 21.6% of the participants have a CD4 count >500 cells/mm3. The majority of the study participants, 86% were in WHO clinical stage I&II and 77.2% were on a 1J (TDF+3TC+DTG) treatment regimen. Among the total participants, 56.3% of participants have HIV-positive family members with a spouse the most reported HIV-positive family members. The mean duration of participants on ART was 90.43 (±48.97) months. Most of the respondents, 92.86% had working functional status and the ability to perform usual work inside or outside the home. Around two-fifths of the participants had an opportunistic infection/s of any kind in the last six months and the most reported opportunistic infection was pneumonia. The majority of respondents 86.5% did not have any support from governmental or non-governmental organizations (Table 1).
Nutritional status of adults on ART
Among the study participants, 19.7% had BMI < 18.5 (underweight), and 72% were in the normal range. Among the respondents, 33.2% reported their actual daily meal pattern to be less than 3 times which is below the daily recommended meal frequency for PLHIV on ART. Among study participant's 44.2%, 30%, and 57.7% escape breakfast, lunch, and dinner respectively. Dietary diversity score was assessed using 9 food items dietary diversity scale in the study group. Almost half, 51.6% of the study participants have inadequate dietary diversity. Other vitamin-rich fruits and vegetables were consumed by 82.4% of respondents. The primary source food for 57.7% of the respondents was own production.
Health-related and immunologic factors among adults on ART
The median CD4 T-Lymphocyte cell count of the participants was 428 with the range of 1307. Almost one-fifth, 21.6% of the participants were with CD4 count >500. The majority of the study participants, 86% were in WHO clinical stage I&II and 77.2% were on a 1J (TDF+3TC+DTG) treatment regimen. Among the total participants, 56.3% of participants have HIV-positive family members and spouses were the most reported HIV-positive family members. The median duration of participants on ART was 84 months with a minimum of 3 months and a maximum of 204 months and a range of 201. Most of the respondents, 92.86% had working functional status and the ability to perform usual work inside or outside the home. Around two-fifths of the participants had an opportunistic infection/s of any kind in the last six months and the most reported opportunistic infection was pneumonia. The majority of respondents 86.5% did not have any support from governmental or non-governmental organizations. (Table 2)
The magnitude of food insecurity among adults on ART
The overall magnitude of food insecurity in this study was 62.4% (95% CI: 57.6, 66.8]. Of which 74(18.1%), 95% CI: (16.7-20.8) were mildly food insecure 96 (23.5%), 95% CI: (21.1-25.2) were moderately food insecure 83 (20.4%), 95% CI: (18.3-22.7) were severely food insecure and 158(37.6.4%) 95% CI: (30.5-40.8) were food secured.
Factors associated with food insecurity among Adults on ART
All variables with a P-value of ≤ 0.25 in bivariate analysis were included in the multivariate regression model. In multivariate analysis, CD4count <350, being WHO stage III&IV, absence of any support, and Low average monthly income were factors associated with food insecurity among adults attending ART. Participants with CD4 count <350 were 3.51 times more likely to have food insecurity than those with CD4 count ≥350 [AOR = 3.51, 95% CI (1.88-6.52)]. Participants with the average monthly household income of ≤ 1000 ETB were 2.34 times more likely to be food insecure than those with an income >1000ETB [AOR: 2.34, 95%CI (1.42-3.84)]. Those with advanced WHO clinical stage (III&IV) were 2.85 times more likely to have food insecurity than stage I&II participants [AOR=2.85, 95% CI (1.61-5.04)]. Those participants who did not get any support were 3.04 times more likely food insecure than those who get support [AOR: 3.04, 95% CI (1.45-6.38)] (Table 3).
Table 3
Multivariable logistic regression Analysis of factors associated with food insecurity in Dessie Referral Hospital of South Wollo Zone, North-central Ethiopia 2020
Variables
|
Category
|
Food security status
|
COR
(95%CI)
|
AOR
(95%CI)
|
Insecure
|
Secure
|
Sex
|
Male
Female
|
115(28.2%)
138(34%)
|
40(9.8%)
114(28%)
|
1
0.42(0.39-1.12)
|
1
0.877(0.50-1.53)
|
Residence
|
Urban
Rural
|
111(27.2%)
142(34.8%)
|
36(3.3%)
132(31.4%)
|
1
1.20(0.51-2.16)
|
1
0.77(0.45-1.32)
|
Head of household
|
Male
Female
|
142(34.8%)
111(27.2%)
|
82(20.1%)
72(17.6%)
|
1
1.12(0.47-3.07)
|
1
0.71(0.40-1.27)
|
Monthly income
|
≤1000ETB
>1000ETB
|
216(53%)
123(30.2%)
|
22(5.4%)
46(11.3%)
|
3.67(1.04-5.40)
1
|
2.34(1.42-3.84) *
1
|
WHO stage of disease
|
Stage I&II
Stage III& IV
|
96(23.5%)
84(20.6%)
|
219(53.8%)
8(1.9%)
|
1
23.9(5.92-35.00)
|
1
2.85(1.61-5.04)*
|
Developed OIs in the last 6 months
|
Yes
No
|
68(16.7%)
84(20.6%)
|
89(21.8%)
165(40.5%)
|
2.59(1.01-3.29)
1
|
1.24(0.74-2.07)
1
|
Support
|
Yes
No
|
46(11.3%)
230(56.5%)
|
9(2.2%)
122(29.9%)
|
1
2.71(1.83-3.88)
|
1
3.04(1.45-6.38)*
|
CD4+ T cell count
|
≤350
350-500
≥500
|
140(34.3%)
29(7.1%)
34(8.3%)
|
111(27.3%)
39(9.5%)
54(13.2%)
|
2.22(2.07-6.53)
0.84(0.45-2.03)
1
|
3.51(1.88-6.52)*
0.91(0.39-2.10)
1
|
Dietary diversity
|
Inadequate
Adequate
|
120(29.4%)
133(32.6%)
|
90(22.1%)
64(15.7%)
|
1.55(1.45-2.02)
1
|
0.65(0.38-1.09)
1
|
* Significant at P-value <0.05, COR = Crude Odd Ratio, AOR=Adjusted odd ratio, CI= Confidence interval, OIs = opportunistic infections |